Smoking Still a Health Risk in the United States

Americans are smoking a lot less than they used to, and that's a good thing. But heavy smoking in the past is still killing people at the older ages in the US and that is an important reason why life expectancy lags behind other rich nations. This is one of the conclusions of a new report from the National Research Council titled “Explaining Divergent Levels of Longevity in High-Income Countries, edited by Eileen M. Crimmins, Samuel H. Preston, and Barney Cohen. Professor Preston, from the University of Pennsylvania, and literally the world's foremost authority on this topic, was interviewed by The Nation's Health, a publication of the American Public Health Association, which summarized the findings:

Over the past 25 years, life expectancy at age 50 in the United States has been increasing, but at a much slower rate than in some other high-income countries. Researchers attribute the slower rate of increase — for women in the United States the increase was about 40 percent smaller than in other countries — to widespread smoking 30 to 50 years ago.

Over the period 1950 to 2003, the gain in life expectancy at age 50 was 2.1 years lower among U.S. women, compared with the average of nine other high-income countries, the report said. Women in the United States, on average, will live 5.7 years longer now than they would have in 1950. In the other nine countries, women are living an average of 7.8 years longer than in 1950.

“What’s clear is that smoking histories matter, and smoking histories can’t be instantaneously reversed when you stop smoking,” Preston said.

Is our lack of universal health care a cause of the problem? Preston thinks this is not a big issue, since most people now die at the older ages, and we do, in fact, have universal health care (Medicare) for the population aged 65 and older. What is more problematic is that the private health care system that exists for everyone younger than 65 is a fee-for-service system that creates profits when people are sick, rather than providing strong incentives for preventive care.

“For main causes of death at older ages — cancer and cardiovascular disease — available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would elsewhere be averted,” the report said.

In fact, Preston said the United States has better cancer detection and survival rates than most other high-income countries. Survival rates following a heart attack are also favorable in the United States, he said.

“Where something has gone awry is in prevention of diseases,” he said. “The (United States) has a very high incidence of chronic disease, though we seem to treat them very well once they occur. We’re not preventing some diseases as effectively as many of our peers.”